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Safety of 3 different reintroduction regimens of antituberculosis drugs after development of antituberculosis treatment-induced hepatotoxicity discount flagyl 400 mg on-line antibiotics for uti how many days. Outcomes of reintroducing anti-tuberculosis drugs following cutaneous adverse drug reactions discount flagyl 400mg mastercard antibiotic resistance youtube. Standardized treatment of active tuberculosis in patients with previous treatment and/or with mono-resistance to isoniazid: a systematic review and meta-analysis flagyl 400mg free shipping infection medication. Multidrug resistant pulmonary tuberculosis treatment regimens and patient outcomes: an individual patient data meta-analysis of 9 generic flagyl 500 mg online antibiotic resistance virtual lab,153 patients. Successful ‘9-month Bangladesh regimen’ for multidrug-resistant tuberculosis among over 500 consecutive patients. Tuberculosis-associated immune reconstitution inflammatory syndrome and unmasking of tuberculosis by antiretroviral therapy. Tuberculosis-associated immune reconstitution inflammatory syndrome: case definitions for use in resource-limited settings. Neurologic manifestations of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome: a case series. Novel relationship between tuberculosis immune reconstitution inflammatory syndrome and antitubercular drug resistance. A clinicopathological cohort study of liver pathology in 301 patients with human immunodeficiency virus/acquired immune deficiency syndrome. Tuberculosis-associated immune reconstitution disease: incidence, risk factors and impact in an antiretroviral treatment service in South Africa. Randomized placebo-controlled trial of prednisone for paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome. Life-threatening exacerbation of Kaposi’s sarcoma after prednisone treatment for immune reconstitution inflammatory syndrome. Response to ‘Does immune reconstitution promote active tuberculosis in patients receiving highly active antiretroviral therapy? Adult respiratory distress syndrome as a severe immune reconstitution disease following the commencement of highly active antiretroviral therapy. Fatal unmasking tuberculosis immune reconstitution disease with bronchiolitis obliterans organizing pneumonia: the role of macrophages. Unveiling tuberculous pyomyositis: an emerging role of immune reconstitution inflammatory syndrome. Effects of human immunodeficiency virus infection on recurrence of tuberculosis after rifampin-based treatment: an analytical review. Cutaneous anergy in pregnant and nonpregnant women with human immunodeficiency virus. Latent tuberculosis detection by interferon gamma release assay during pregnancy predicts active tuberculosis and mortality in human immunodeficiency virus type 1-infected women and their children. Performance of an interferon-gamma release assay to diagnose latent tuberculosis infection during pregnancy. Antiretroviral program associated with reduction in untreated prevalent tuberculosis in a South African township. American Thoracic Society, Centers for Disease Control and Prevention, Infectious Diseases Society of America. Treatment of multidrug-resistant tuberculosis during pregnancy: a report of 7 cases. Multidrug-resistant tuberculosis in pregnancy: case report and review of the literature. Treatment of multidrug-resistant tuberculosis during pregnancy: long-term follow-up of 6 children with intrauterine exposure to second-line agents. Drug-resistant tuberculosis and pregnancy: treatment outcomes of 38 cases in Lima, Peru. Pregnancy outcome following gestational exposure to fluoroquinolones: a multicenter prospective controlled study. Effects of hydroxymethylpyrimidine on isoniazid- and ethionamide-induced teratosis. Study of teratogenic activity of trifluoperazine, amitriptyline, ethionamide and thalidomide in pregnant rabbits and mice. The mode of transmission is thought to be through inhalation, ingestion, or inoculation via the respiratory or gastrointestinal tract. Symptoms include fever, night sweats, weight loss, fatigue, diarrhea, and abdominal pain. Other focal physical findings or laboratory abnormalities may occur with localized disease. Localized syndromes include cervical or mesenteric lymphadenitis, pneumonitis, pericarditis, osteomyelitis, skin or soft-tissue abscesses, genital ulcers, or central nervous system infection. Other ancillary studies provide supportive diagnostic information, including acid-fast bacilli smear and culture of stool or tissue biopsy material, radiographic imaging, or other studies aimed at isolating organisms from focal infection sites. Available information does not support specific recommendations regarding avoidance of exposure. Azithromycin and clarithromycin also each confer protection against respiratory bacterial infections. Patients will need continuous antimycobacterial treatment unless they achieve immune reconstitution via antiretroviral drugs. Improvement in fever and a decline in quantity of mycobacteria in blood or tissue can be expected within 2 to 4 weeks after initiation of appropriate therapy; clinical response may be delayed, however, in those with more extensive disease or advanced immunosuppression. Adverse effects with clarithromycin and azithromycin include nausea, vomiting, abdominal pain, abnormal taste, and elevations in liver transaminase levels or hypersensitivity reactions. Managing Treatment Failure Treatment failure is defined by the absence of a clinical response and the persistence of mycobacteremia after 4 to 8 weeks of treatment. The regimen should consist of at least two new drugs not used previously, to which the isolate is susceptible. Two studies, each with slightly more than 100 women with first-trimester exposure to clarithromycin, did not demonstrate an increase in or specific pattern of defects, although an increased risk of spontaneous abortion was noted in one study. Diagnostic considerations and indications for treatment of pregnant women are the same as for women who are not pregnant. Pregnant women whose disease fails to respond to a primary regimen should be managed in consultation with infectious disease and obstetrical specialists. Microbiology and Minimum Inhibitory Concentration Testing for Mycobacterium avium Complex Prophylaxis. A prospective, randomized trial examining the efficacy and safety of clarithromycin in combination with ethambutol, rifabutin, or both for the treatment of disseminated Mycobacterium avium complex disease in persons with acquired immunodeficiency syndrome. Early manifestations of disseminated Mycobacterium avium complex disease: a prospective evaluation. Incidence of Mycobacterium avium-intracellulare complex bacteremia in human immunodeficiency virus-positive patients. Incidence and natural history of Mycobacterium avium- complex infections in patients with advanced human immunodeficiency virus disease treated with zidovudine. Disseminated Mycobacterium avium-intracellulare infection in acquired immunodeficiency syndrome mimicking Whipple’s disease. Mycobacterium avium complex infection presenting as endobronchial lesions in immunosuppressed patients. Mycobacterial lymphadenitis associated with the initiation of combination antiretroviral therapy. Mycobacterial lymphadenitis after initiation of highly active antiretroviral therapy. Prophylaxis against disseminated Mycobacterium avium complex with weekly azithromycin, daily rifabutin, or both.

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Even if you don’t qualify for Extra Help now buy flagyl 250 mg overnight delivery antibiotics for acne pros and cons, you can apply or reapply later if your income and resources change order 400 mg flagyl mastercard virus java update. Other ways to save if you don’t get Extra Help Tere are other ways you may also be able to save generic flagyl 500 mg without prescription antibiotics for uti at walmart. Ask your doctor if there are generic effective 400 mg flagyl infection under eye, over-the-counter, or less-expensive brand-name drugs that could work just as well as the ones you’re taking now. Switching to lower-cost drugs can save you hundreds or possibly thousands of dollars a year. Exploring National- and Community-Based Programs that may have programs that can help you with your drug costs, like the National Patient Advocate Foundation or the National Organization for Rare Disorders. Get information on federal, state, and private assistance programs in your area by visiting beneftscheckup. Virgin Islands ofer some type of coverage to help people with Medicare with paying drug plan premiums and/or cost sharing. Many of the major drug manufacturers ofer assistance programs for people enrolled in a Medicare drug plan. Words in red are Medicare works with other government representatives, defned community- and faith-based groups, employers and unions, doctors, on pages pharmacies, and other people and organizations to educate people 83–86. Look for information in your local newspaper, or listen for information on the radio, about events in your community. If you have limited income and resources, you may qualify for Extra Help paying the costs of Medicare drug coverage. Before you make a decision, get answers to these questions: Do I have creditable prescription drug coverage now? Tis may be important if a plan you want to join requires you to use certain pharmacies. I have Medicare and a Medicare Supplement Insurance (Medigap) policy without drug coverage You can join a Medicare drug plan by: 1. Keeping your current Medigap policy and enrolling in a Medicare Prescription Drug Plan. If you already have a Medigap policy, you can’t use it to pay for out-of-pocket costs under your Medicare Advantage Plan. However, you might not be able to get the same Medigap policy back if you leave the Medicare Advantage Plan and then go back to Original Medicare, or you may end up paying higher premiums for the Medigap policy. You have a legal right to keep your Medigap policy, but rights to buy a Medigap policy may vary by state. For more information about your Medigap policy, contact your Medigap insurance company or visit Medicare. If you’re joining a Medicare Advantage Plan for the frst time, you may get a 12-month trial period during which you can disenroll from the Medicare Advantage Plan and get back your Medigap policy, or if it isn’t available, buy another Medigap policy. If you still have a Medigap policy with drug coverage, red are your Medigap insurer must send you a detailed notice each year defned describing your choices for drug coverage and stating whether its on pages drug coverage is creditable prescription drug coverage. You would get all your health care coverage including drug coverage from this plan, and you wouldn’t need a Medigap policy. Information you get from your Medigap insurance company describes these choices in detail. You can also check with your State Insurance Department to fnd out what other options you may have for drug coverage. Tip: Contact your Medigap insurance company before you make any changes to your drug coverage. Tey must remove the drug coverage from your Medigap policy and adjust your premium based on this change. Also, you may have to pay a lifetime late enrollment penalty to join a Medicare Prescription Drug Plan if the drug coverage you’ve had under your Medigap policy isn’t creditable prescription drug coverage. You may have to pay this higher premium for as long as you’re in a Medicare Prescription Drug Plan. I have Medicare and get drug coverage from a current or former employer or union Before making a decision about whether to join a Medicare drug plan, fnd out how your employer or union drug coverage works with Medicare, because your coverage may change if you join a Medicare drug plan. Your employer or union (or the plan that administers your drug coverage) will send you a “Creditable Coverage” disclosure each year, letting you know if it’s creditable prescription drug coverage and how it compares to Medicare drug coverage. Read carefully, and save all materials from your employer or union to know your options. You may have to make choices about your employer/union drug coverage and Medicare drug coverage: During your 7-month Initial Enrollment Period, when you frst become eligible for Medicare (see page 18 for details) During Open Enrollment, between October 15–December 7 each year When your employer/union coverage changes or ends 53 Your Coverage Choices 4 I have Medicare and get drug coverage from a current or former employer or union (continued) Some important questions to answer before making a decision: Is your employer or union drug coverage creditable (on average, does it expect to pay at least as much as standard Medicare drug coverage)? If not, in most cases, you’ll have to pay a late enrollment penalty if you don’t join a Medicare drug plan when you’re frst eligible. Note: Keep materials your employer or union sends you that tell you your drug coverage is creditable. You may need to show it to your Medicare drug plan as proof of creditable prescription drug coverage if you decide to join a Medicare drug plan later. If you don’t enroll when you’re frst eligible, you may have to wait to join a Medicare drug plan until Open Enrollment, which is October 15–December 7. You may be able to do one of these: Keep your current employer or union drug coverage, and join a Medicare drug plan to get more complete drug coverage. If you join a Medicare drug plan later, you may have to pay a late enrollment penalty if your current drug coverage isn’t creditable. Words in Drop your current coverage and join a Medicare drug plan, or red are join a Medicare health plan that covers prescription drugs. You also may not be able to drop your employer or union drug coverage without also dropping your employer or union health coverage. If you drop coverage for yourself, you may also have to drop coverage for your spouse and dependents. Medicare doesn’t have information about how your current employer or union drug coverage will be afected by your enrollment in a Medicare drug plan, so talk to your employer or union’s benefts administrator before you make any decisions about your drug coverage. It’ll almost always be to your advantage to keep your current coverage without any changes. It’s almost always on pages to your advantage to keep your current coverage without any changes. Words in Because you have Medicaid, Medicare automatically gives you Extra Help red are with your Medicare drug plan costs. If you live in an institution (like a nursing home), in most on pages cases, you pay nothing for your covered drugs. If you haven’t joined a Medicare drug plan, Medicare will enroll you in a drug plan to make sure you have drug coverage (unless you already have certain retiree drug coverage). Medicare sends you a yellow notice telling you what drug plan you’re in and when your coverage starts. Check to see if the plan covers the drugs you take and includes the pharmacies you use. If you flled any covered prescriptions before your Medicare drug plan coverage started, you may be able to get back some of the money you spent. In limited cases, some state Medicaid programs may pay for drugs Medicare doesn’t cover. If you continue to qualify for Medicaid, Medicaid will still cover the other health care costs that Medicare doesn’t cover. If you aren’t sure whether you still qualify for Medicaid, call your State Medical Assistance (Medicaid) ofce. If you don’t join a Medicare drug plan on your own, Medicare will enroll you in a Medicare Prescription Drug Plan, to make sure you have coverage, unless you already have certain retiree drug coverage. Medicare sends you a yellow or a green notice letting you know when your coverage begins. You can switch to a diferent Medicare drug plan at any time as long as you continue to qualify for Extra Help. You can change your mind and join a Medicare drug plan at any time without paying a late enrollment penalty as long as you continue to qualify for Extra Help.

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Expanded access to naloxone through large health systems could prevent overdose fatalities in broad populations of patients order 200 mg flagyl amex antibiotic for uti pseudomonas, including patients who may experience accidental overdose from misusing their medications purchase flagyl 250 mg visa antibiotics for acne after accutane. In a study within one health plan discount flagyl 200mg on line bacteria are the simplest single cells that, one third of the most common and costly medical conditions were markedly more prevalent among patients with substance use disorders than they were among similar health system members who did not have a substance use disorder quality flagyl 200mg antibiotics kill bacteria. In addition to chronic care management for severely affected individuals, coordinating services for those with mild or moderate problems is also important. Studies of various methods for integrating substance use services and general medical care have typically shown benefcial outcomes. This approach to care delivery proceeds on the assumption that services for the range of substance use disorders should be fully integrated components of mainstream health care. Performance measurement has the dual purpose of accountability and quality improvement. Many measures are being tested by public and private health plans, though most have not been adopted widely for quality improvement and accountability. A measure of care continuity after emergency department use for substance use disorders is in process. Because substance use disorder treatment is currently not well integrated and services are often provided by multiple systems, it can be challenging to effectively measure treatment quality and related outcomes. The ability to track service delivery across these multiple environments will be critical for addressing this challenge. For example, community monitoring systems to assess risk and protection for adolescents are being developed. It has been used more in general health care than in substance use disorder treatment. However, Delaware and Maine have experimented with it in their public substance use disorder treatment systems, and several studies have found improvement in retention and outcomes. Although pay-for-performance is a promising approach, more research is needed to address these concerns. A fundamental concept in care coordination between the health care, substance use disorder treatment, and mental health systems is that there should be “no wrong door. In one such model, coordination ranges from referral agreements to co-located substance use disorder, mental health, and other health care services. Importantly, the models all emphasize the relationship between person-centered, high-quality care and fully integrated models. Integration Can Help Address Health Disparities Integrating substance use services with general health care (e. Prevalence of substance misuse and substance use disorders differs by race and ethnicity, sex, age, sexual orientation, gender identity, and disability, and these factors are also associated with differing rates of access to both health care and substance use disorder treatment. A study of a large health system found that Black or African American women but not Latina or Asian American women were less likely to attend substance use disorder treatment, after controlling for other factors; there were no ethnicity differences for men. A fundamental way to address disparities is to increase the number of people who have health coverage. The Affordable Care Act provides several mechanisms that broaden access to coverage. As a result, more low- income individuals with substance use disorders have gained health coverage, changed their perceptions about being able to obtain treatment services if needed, and increased their access to treatment. Individuals whose incomes are too high to qualify for Medicaid but are not high enough to be eligible for qualifed health plan premium tax credits also rarely have coverage for substance use disorder treatment. Because the new Medicaid population includes large numbers of young, single men—a group at much higher risk for alcohol and drug misuse— Medicaid enrollees needing treatment could more than double, from 1. Ineligible for Financial Assistance share includes those ineligible due to offer of employer sponsored insurance or income. Source: Kaiser Family Foundation analysis based on 2015 Medicaid eligibility levels and 2015 Current Population Survey. Several interventions have been adapted explicitly to address differences in specifc populations; they were either conducted within health care settings or are implementable in those settings. The list below provides examples of such programs that have been shown to be effective in diverse populations: $ An evidence-based prevention intervention focused 1 on women who are at risk for an alcohol-exposed pregnancy because of risky drinking and not using See Chapter 3 - Prevention contraception consistently and correctly. However, rural clinics did signifcantly less following up for substance use problems in their patients than their urban counterparts. In other words, it is expected that the number of people who seek treatment across all racial and ethnic groups will increase. However, some studies have examined race and ethnicity as predictors of outcomes in analyses controlling for many other factors (such as age, substance use disorder severity, mental health severity, social supports), and they showed that after accounting for these socioeconomic factors, outcomes did not differ by race and ethnicity. Some examples from an integrated health system include adolescent studies comparing Blacks or African Americans, American Indians or Alaska Natives, Hispanics or Latinos, and Whites. For example, studies have found that matching programs and providers by race or ethnicity may produce better results for Hispanics or See the section on “Considerations Latinos than for other racial and ethnic groups. These laws require individual assessment of a person with a disability, identifying and implementing needed reasonable modifcations of policies and practices when necessary to provide an equal opportunity for a person with a disability to participate in and beneft from treatment programs. More generally, these laws prohibit programs from excluding individuals from treatment programs on the basis of a co- occurring disability, if the individual meets the qualifcations for the program. One example with cultural relevance is a pilot randomized trial of a computer-delivered brief intervention in a prenatal clinic, which matched health care professionals and patients on race/ethnicity; patients found the intervention to be easy to use and helpful. Integration Can Reduce Costs of Delivering Substance Use Services With scarce resources and many social programs competing for limited funding, cost-effectiveness is a critical aspect of substance use-related services. Over the past 20 years, several comprehensive literature reviews have examined the economics of substance use disorder treatment. The value of societal savings also stem from fewer interpersonal conficts, total benefts minus total costs. The accumulated costs to the individual, the family, and the community are staggering and arise as a consequence of many direct and indirect effects, including compromised physical and mental health, loss of productivity, reduced quality of life, increased crime and violence, misuse and neglect of children, and health care costs. Criminal Justice System As described elsewhere in this Report, a substance use disorder is a substantial risk factor for committing a criminal offense. Reduced crime is thus a key component of the net benefts associated with prevention and treatment interventions. Overall, within the criminal justice system, more than two thirds of jail detainees and half of prison inmates experience substance use disorders. The estimated prevalence of substance use disorders among parents involved in the child welfare system varies across service populations, time, and place. One widely cited estimate is that between one-third and two-thirds of parents involved with the child welfare system experience some form of substance use problem. Children of parents with substance use problems were more likely than others to require child protective services at younger ages, to experience repeated neglect and abuse from parents, and to otherwise require more intensive and intrusive services. Substance use disorders appear to account for a large proportion of child welfare, foster care, and related expenditures in the United States. Further, service members and veterans suffer from high rates of co-occurring health problems that pose signifcant treatment challenges, including traumatic brain injury, post-traumatic stress disorder, depression, and anxiety. These expenditures might be reduced through more aggressive measures to address substance misuse problems and accompanying disorders. Moreover, many substance use-related services provided through criminal justice, child welfare, or other systems seek to ameliorate serious harms that have already occurred, and that might have been prevented with greater impact or cost-effectiveness through the delivery of evidence-based prevention or early treatment interventions. Economic Analyses can Assess the Value of Substance Use Interventions Different kinds of economic analyses can be particularly useful in helping health care systems, community leaders, and policymakers identify programs or policies that will bring the greatest value for addressing their needs. Two commonly used types of analyses are cost-effectiveness analysis199 and cost-beneft analysis.

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It is therefore desirable that such groups should be distributed in separate prisons suitable for the treatment of each group order flagyl 500 mg overnight delivery antibiotic 3 pack. It is desirable to provide varying degrees of security according to the needs of different groups generic 200 mg flagyl visa do antibiotics for acne work. Open prisons generic 400 mg flagyl amex virus ebola, by the very fact that they provide no physical security against escape but rely on the self-discipline of the inmates flagyl 200mg sale antibiotics gas, provide the conditions most favourable to the rehabilitation of carefully selected prisoners. It is desirable that the number of prisoners in closed prisons should not be so large that the individualization of treatment is hindered. In some countries it is considered that the population of such prisons should not exceed 500. On the other hand, it is undesirable to maintain prisons which are so small that proper facilities cannot be provided. There should, therefore, be governmental or private agencies capable of lending the released prisoner efficient aftercare directed towards the lessening of prejudice against him or her and towards his or her social rehabilitation. Treatment Rule 91 The treatment of persons sentenced to imprisonment or a similar measure shall have as its purpose, so far as the length of the sentence permits, to establish in them the will to lead law-abiding and self-supporting lives after their release and to fit them to do so. The treatment shall be such as will encourage their self-respect and develop their sense of responsibility. To these ends, all appropriate means shall be used, including religious care in the countries where this is possible, education, vocational guidance and training, social casework, employment counselling, physical develop- ment and strengthening of moral character, in accordance with the individual needs of each prisoner, taking account of his or her social and criminal history, physical and mental capacities and aptitudes, personal temperament, the length of his or her sentence and prospects after release. For every prisoner with a sentence of suitable length, the prison director shall receive, as soon as possible after his or her admission, full reports on all the matters referred to in paragraph 1 of this rule. Such reports shall always include a report by the physician or other qualified health-care professionals on the physical and mental condition of the prisoner. This file shall be kept up to date and classified in such a way that it can be consulted by the responsible personnel whenever the need arises. The purposes of classification shall be: (a) To separate from others those prisoners who, by reason of their criminal records or characters, are likely to exercise a bad influence; (b) To divide the prisoners into classes in order to facilitate their treat- ment with a view to their social rehabilitation. So far as possible, separate prisons or separate sections of a prison shall be used for the treatment of different classes of prisoners. Rule 94 As soon as possible after admission and after a study of the personality of each prisoner with a sentence of suitable length, a programme of treatment shall be prepared for him or her in the light of the knowledge obtained about his or her individual needs, capacities and dispositions. Sentenced prisoners shall have the opportunity to work and/or to actively participate in their rehabilitation, subject to a determination of physical and mental fitness by a physician or other qualified health-care professionals. Sufficient work of a useful nature shall be provided to keep prisoners actively employed for a normal working day. No prisoner shall be required to work for the personal or private benefit of any prison staff. So far as possible the work provided shall be such as will maintain or increase the prisoners’ ability to earn an honest living after release. Vocational training in useful trades shall be provided for prisoners able to profit thereby and especially for young prisoners. Within the limits compatible with proper vocational selection and with the requirements of institutional administration and discipline, prisoners shall be able to choose the type of work they wish to perform. The organization and methods of work in prisons shall resemble as closely as possible those of similar work outside of prisons, so as to prepare prisoners for the conditions of normal occupational life. The interests of the prisoners and of their vocational training, however, must not be subordinated to the purpose of making a financial profit from an industry in the prison. Preferably, institutional industries and farms should be operated directly by the prison administration and not by private contractors. Where prisoners are employed in work not controlled by the prison administration, they shall always be under the supervision of prison staff. Unless the work is for other departments of the government, the full normal wages for such work shall be paid to the prison administration by the persons to whom the labour is supplied, account being taken of the output of the prisoners. The precautions laid down to protect the safety and health of free workers shall be equally observed in prisons. Provision shall be made to indemnify prisoners against industrial injury, including occupational disease, on terms not less favourable than those extended by law to free workers. The maximum daily and weekly working hours of the prisoners shall be fixed by law or by administrative regulation, taking into account local rules or custom in regard to the employment of free workers. The hours so fixed shall leave one rest day a week and sufficient time for education and other activities required as part of the treatment and rehabilitation of prisoners. Under the system, prisoners shall be allowed to spend at least a part of their earnings on approved articles for their own use and to send a part of their earnings to their family. The system should also provide that a part of the earnings should be set aside by the prison administration so as to constitute a savings fund to be handed over to the prisoner on his or her release. Provision shall be made for the further education of all prisoners capable of profiting thereby, including religious instruction in the countries where this is possible. So far as practicable, the education of prisoners shall be integrated with the educational system of the country so that after their release they may continue their education without difficulty. Rule 105 Recreational and cultural activities shall be provided in all prisons for the benefit of the mental and physical health of prisoners. Social relations and aftercare Rule 106 Special attention shall be paid to the maintenance and improvement of such relations between a prisoner and his or her family as are desirable in the best interests of both. Rule 107 From the beginning of a prisoner’s sentence, consideration shall be given to his or her future after release and he or she shall be encouraged and provided assistance to maintain or establish such relations with persons or agencies outside the prison as may promote the prisoner’s rehabilitation and the best interests of his or her family. Services and agencies, governmental or otherwise, which assist released prisoners in re-establishing themselves in society shall ensure, so far as is possible and necessary, that released prisoners are provided with appropriate documents and identification papers, have suitable homes and work to go to, are suitably and adequately clothed having regard to the climate and season and have sufficient means to reach their destination and maintain themselves in the period immediately following their release. The approved representatives of such agencies shall have all necessary access to the prison and to prisoners and shall be taken into consultation as to the future of a prisoner from the beginning of his or her sentence. It is desirable that the activities of such agencies shall be centralized or coordinated as far as possible in order to secure the best use of their efforts. Persons who are found to be not criminally responsible, or who are later diagnosed with severe mental disabilities and/or health conditions, for whom staying in prison would mean an exacerbation of their condition, shall not be detained in prisons, and arrangements shall be made to transfer them to mental health facilities as soon as possible. If necessary, other prisoners with mental disabilities and/or health conditions can be observed and treated in specialized facilities under the supervision of qualified health-care professionals. The health-care service shall provide for the psychiatric treatment of all other prisoners who are in need of such treatment. Rule 110 It is desirable that steps should be taken, by arrangement with the appropriate agencies, to ensure if necessary the continuation of psychiatric treatment after release and the provision of social-psychiatric aftercare. Persons arrested or imprisoned by reason of a criminal charge against them, who are detained either in police custody or in prison custody (jail) but have not yet been tried and sentenced, will be referred to as “untried prisoners” hereinafter in these rules. Without prejudice to legal rules for the protection of individual liberty or prescribing the procedure to be observed in respect of untried prisoners, these prisoners shall benefit from a special regime which is described in the following rules in its essential requirements only. Young untried prisoners shall be kept separate from adults and shall in principle be detained in separate institutions. Rule 114 Within the limits compatible with the good order of the institution, untried prisoners may, if they so desire, have their food procured at their own expense from the outside, either through the administration or through their family or friends. Rule 115 An untried prisoner shall be allowed to wear his or her own clothing if it is clean and suitable. If he or she wears prison dress, it shall be different from that supplied to convicted prisoners. Rule 116 An untried prisoner shall always be offered the opportunity to work, but shall not be required to work. Rule 117 An untried prisoner shall be allowed to procure at his or her own expense or at the expense of a third party such books, newspapers, writing material and other means of occupation as are compatible with the interests of the administration of justice and the security and good order of the institution. Rule 118 An untried prisoner shall be allowed to be visited and treated by his or her own doctor or dentist if there are reasonable grounds for the application and he or she is able to pay any expenses incurred. Every untried prisoner has the right to be promptly informed about the reasons for his or her detention and about any charges against him or her. If an untried prisoner does not have a legal adviser of his or her own choice, he or she shall be entitled to have a legal adviser assigned to him or her by a judicial or other authority in all cases where the interests of justice so require and without payment by the untried prisoner if he or she does not have sufficient means to pay. Denial of access to a legal adviser shall be subject to independent review without delay.

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